Provider Demographics
NPI:1477544021
Name:BEAN, ETHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:
Last Name:BEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3040 HAMMOND BUSINESS PL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3666
Mailing Address - Country:US
Mailing Address - Phone:919-899-6259
Mailing Address - Fax:919-838-9074
Practice Address - Street 1:3040 HAMMOND BUSINESS PL
Practice Address - Street 2:SUITE 105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3666
Practice Address - Country:US
Practice Address - Phone:919-899-6259
Practice Address - Fax:919-838-9074
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-002362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry